Childhood obesity has become a central concern in many countries and a range of policies have been implemented or proposed to address it. This co-authored book is the first to focus on the ethical and policy questions raised by childhood obesity and its prevention. -/- Throughout the book, the authors emphasize that childhood obesity is a multi-faceted phenomenon, and just one of many issues that parents, schools and societies face. They argue that it is (...) important to acknowledge the resulting complexities and not to think in terms "single-issue" policies. -/- After first reviewing some of the factual uncertainties about childhood obesity, the authors explore central ethical questions. What priority should be given to preventing obesity? To what extent are parents responsible? How should we think about questions of stigma and inequality? In the second part of the book, the authors consider key policy issues, including the concept of the 'obesogenic environment,' debates about taxation and marketing, and the role that schools can play in obesity prevention. -/- The authors argue that political debate is needed to decide the importance given to childhood obesity and how to divide responsibilities for action. These debates have no simple answers. Nonetheless, the authors argue that there are reasons for hope. There are a wide range of opportunities for action. Many of these options also promise wider social benefits. (shrink)

Childhood obesity has become a public health epidemic, and currently a battle exists over how to frame and address this problem. This paper explores how public policy approaches can be employed to address obesity. We present the argument that obesity should be viewed as the consequence of a “toxic environment” rather than the result of the population failing to take enough “personal responsibility.” In order to make progress in decreasing the prevalence of obesity, we must (...) shift our view of obesity away from the medical model to a public health model . At the same time, we must be sensitive to the problem of weight bias.Potential obstacles to taking a public policy approach are identified, as well as suggestions on how to overcome them. (shrink)

Childhood obesity is an increasing health threat. The National Institutes of Health is the primary funding agency for research into the causes, mechanisms, consequences, and prevention and treatment of childhood obesity. Using the NIH Strategic Plan for Obesity Research as the framework, this article summarizes the research that has been funded in the past five years as well as new research areas with great potential.

Childhood obesity continues to rise in the United States, with now over 17% of children and adolescents considered overweight. Childhood obesity predisposes an entire generation to increased risk of chronic diseases and disabilities and is a severe threat to the economic well-being of the nation. At first thought, the solution to the obesity epidemic may seem simple: encourage people to eat less and exercise more. However, the reality is that behavioral change is difficult to achieve (...) without also considering the interplay of genetics, biological processes, and social and environmental mechanisms. As such, investment in obesity research has been considered an important tool to combat obesity and obesity-related diseases. Childhood obesity research, in particular, has drawn considerable attention, given the lower cost of prevention relative to treatment and the high potential for long-term benefits at a population level. (shrink)

After years of near total neglect, the problem of childhood obesity is now in the limelight. Terms like “epidemic,” “crisis,” and “emergency” are used frequently when describing the trend. Progress is defined with strong language and fueled by statistics such as the observation that this generation of children will be the first to live shorter lives than their parents. Multi-disciplinary journals such as the Journal of Law, Medicine & Ethics have dedicated symposiums to the issue, and conferences have (...) been convened not only by health professionals but by government agencies, the food industry, and even professionals who market to children. The seriousness of childhood obesity is no longer in doubt, and finally attention has turned to the more complex question – what must be done? (shrink)

Schools are ideal settings for implementing multi-component programs to prevent and control childhood obesity. Thoughtful improvements to proven strategies, coupled with careful evaluation, can contribute to accumulation of evidence needed to design and implement the next generation of optimal interventions.

The obesity epidemic among children and adolescents in the United States continues to worsen. The most recent analysis of data from the National Health and Nutrition Examination Survey showed that the prevalence of overweight among children and adolescents – defined as a Body Mass Index at or above the 95th percentile on gender-specific BMI-for-age growth charts developed by the Centers for Disease Control and Prevention – increased significantly between 1999-2000 and 2003-2004. Over this period, the prevalence of overweight among (...) children and adolescents aged 2-19 increased 23% – from 13.9% to 17.1%. In 2003-2004, 18.8% of children aged 6-11 and 17.4% of adolescents aged 12-19 were overweight. Roughly comparable proportions of each age group were considered to be at risk of becoming overweight. (shrink)

Childhood obesity is in important respects a result of legal policies that influence both dietary intake and physical activity. The law must shift focus away from individual risk factors alone and seek instead to promote situational and environmental influences that create an atmosphere conducive to health. To attain this goal, advocates should embrace a population-wide model of public health, and policymakers must critically examine the fashionable rhetoric of consumer choice.

Childhood obesity is a serious problem for increasing numbers of children around the world. According to the International Obesity Task Force, 1 of 10 schoolaged children worldwide is overweight or obese, a number totaling 155 million; of these, 2-3% are obese. Prevalence is highest in the Americas and Europe, followed by the Near/Middle East, with smaller but growing numbers in the Asia-Pacific and Sub-Saharan regions of the world.In the United States, which provides the data for much of (...) this report, prevalence continues to rise. The most recent nationally representative data indicate that 33.6% of individuals aged 2-19 years were overweight and 17.1% were at risk for overweight in 2003-2004, compared to 28.2% and 13.9% in 1999-2000, respectively. In this age group, the prevalence of overweight or at risk for overweight was highest among Mexican Americans, followed by Non-Hispanic blacks and Non-Hispanic whites, and a higher percentage of males were overweight compared to females. (shrink)

Despite unprecedented medical advancements and the near eradi­cation of many serious diseases, there are growing epidemics of preventable illness brought about in part by the overemphasis on individual autonomy and the neglect of obligations to others. Insofar as these diseases develop because of individual choice, this permissiveness hampers the moral analysis of growing epidemics like childhood obesity. While society has contributed to its rapid progression, childhood obesity finds its origins in lifestyle choices implemented at home. Consequently, (...) parents have an unparalleled duty to prevent and correct obesity and unhealthy lifestyles in their children. Failure to do so undoubtedly violates a parent’s duty and suggests medical neglect. However, our current understanding of medical neglect is too narrow to be applicable to chronic, preventable illnesses. Relevant principles of tort law may broaden our understanding of neglect to better reflect the nature of parental and societal liability in preventable illnesses. (shrink)

Childhood obesity is a serious problem for increasing numbers of children around the world. According to the International Obesity Task Force, 1 of 10 schoolaged children worldwide is overweight or obese, a number totaling 155 million; of these, 2-3% are obese. Prevalence is highest in the Americas and Europe, followed by the Near/Middle East, with smaller but growing numbers in the Asia-Pacific and Sub-Saharan regions of the world.In the United States, which provides the data for much of (...) this report, prevalence continues to rise. The most recent nationally representative data indicate that 33.6% of individuals aged 2-19 years were overweight and 17.1% were at risk for overweight in 2003-2004, compared to 28.2% and 13.9% in 1999-2000, respectively. In this age group, the prevalence of overweight or at risk for overweight was highest among Mexican Americans, followed by Non-Hispanic blacks and Non-Hispanic whites, and a higher percentage of males were overweight compared to females. (shrink)

Childhood obesity has become a global public health issue. Today, there are opportunities to promote health through technological devices such as serious games. Despite the major advancement of this field of research, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects. In this perspective article, we report the pros and cons of existing serious games. Besides, we attempt to propose a new methodology of design of a serious game (...) that could help to cope with childhood obesity. The proposed idea consists of a serious game in virtual reality based on enjoyment, movement, education, and executive functioning training. Longitudinal studies and solid research protocol would certainly ensure consistency and aid interpretation. (shrink)

Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be responsible for their children’s obesity, and if so, whether parental responsibility ought to be addressed in the physician–patient/parent encounter. We illustrate how different ideal-typical models of the physician–patient/parent interaction emphasise (...) different understandings of patient autonomy and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents’ role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children’s welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents’ capacities. A deliberative-oriented physician–patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule. (shrink)

The purpose of this article is to comprehensively review studies that have examined the relation between diet and childhood obesity. The review specifically considers the roles of total energy intake and energy density; dietary composition; individual foods, food groups, and dietary patterns; beverage consumption; and eating behaviors. The paper also discusses methodological considerations and future research directions and concludes by summarizing the evidence presented and highlighting the ethical issues surrounding providing dietary advice.

Few studies have examined the influence of the food environment on obesity rates among very young, low-income consumers. This research contributes to this growing literature by examining the relationship between modifications to the retail environment and obesity rates for low-income, preschool-aged children. Based on data combined from various secondary sources, this study finds that changes in the retail environment are significantly related to obesity rates. More specifically, the authors find a positive relationship between the number of convenience (...) stores in the retail environment and obesity rates among low-income, preschool-aged children. Results also show that the percent change in grocery stores and supercenters and club stores in the retail environment is negatively related to the obesity rates of low-income, preschool-aged children [i.e., as grocery stores and supercenters/club stores increase, obesity decreases ].Further, the percent change in supercenters and club stores mediates the positive relationship between participation in the Supplemental Nutrition Assistance Program and obesity rates. (shrink)

Bringing the 12.8% of children with special healthcare needs into the national response to the childhood obesity epidemic will require new information, a view of health promotion beyond that which occurs within healthcare systems, and services and supports in addition to the multi-sectoral strategies presently designed for children overall. These efforts are necessary to protect the health of the nation's 9.4 million children with special health care needs now and long-term.

Consumption of sugar-sweetened beverages contributes to multiple health problems including obesity, diabetes, and tooth decay, especially among children. Excise taxation has been proven efficacious in changing purchasing behaviors related to tobacco use with resulting improvements in public health outcomes. Similar taxes applied to SSBs are starting to take hold internationally and domestically. SSB taxes have been proposed in over 30 U.S. jurisdictions since 2009, but only Berkeley has passed and implemented one to date. Given empirical evidence of their effectiveness, (...) governments should consider implementation of SSB excise taxes based on uniform definitions of SSBs and other factors. (shrink)

Fermented dairy products such as yogurt contain many bioactive compounds. In addition, probiotic yogurts are an invaluable source of probiotic bacteria and are a group of probiotic products best accepted by children. There is plenty of research indicating an interdependence between yogurt consumption, body mass index, and adipose tissue percentage, which suggests that yogurt consumption may contribute to reducing the risk of becoming overweight or obese. In turn, the occurrence of overweight and obesity may be accompanied by a reduced (...) sensitivity to sweetness, which modifies food preference selection and acceptance, including with yogurt. This study aimed to assess the preferences and consumption of yogurt in terms of sensitivity to recognize sweetness and obesity in a group of 7–9-year-old children. Body mass index and adipose tissue percentage obesity indicators were determined, and the frequency of fermented milk product consumption was assessed about the results of the sweetness recognition test as well as yogurt preferences. There was no significant relationship between body weight and the frequency of fermented milk product consumption. Correlations were found between the values of body mass index and the ability to recognize sweetness, which was significantly better recognized by underweight children or at normal body weight, moreover, those children with a higher ability to recognize sweetness significantly more frequently preferred plain unsweetened yogurt. (shrink)

Although the obesity epidemic appears to have affected all segments of the U.S. population, its impact on children with special health care needs has received little attention. “Children with special health care needs” is a term used in the U.S. to describe children who come to the attention of health care providers and policy makers because they need different services and supports than other children. Government, at both the federal and state levels, has long felt a particular responsibility for (...) safeguarding the health of children with special needs. The definition “children with special health care needs,” in fact, was developed by a work group established by the U.S. Maternal and Child Health Bureau to assist states in their efforts to develop community systems of services for children with complex medical and behavioral conditions. (shrink)

Obesity and poverty in childhood are widely studied phenomena and despite mixed results, some findings are without doubt: they come with various experiences of mental, physical and social harm, have therefore negative effects on the well-being of children, and they intersect in relation with race, class and gender. In this contribution we analyze child obesity and poverty from a philosophical social justice perspective, which has, to a large extent, so far neglected this topic. We show how they (...) compromise social justice and argue that there is an obligation to implement structural changes to assist the affected children and their families. However, we make also clear that such interventions must not happen in accordance to the current neoliberal fitness and health ideology and its related narrow individualism. (shrink)

Childhood overweight and obesity, especially among migrant children, are current health problems in several European countries. In the present study the prevalence of overweight and obesity among migrant children from Turkey and the former Yugoslavia was documented and compared with that of Austrian children in Vienna. Anthropometric data from 1786 children were collected at the ages of 6, 10 and 15 years. Body mass was estimated by means of the body mass index and percentile curves were used (...) to determine weight status. The prevalence of overweight and obesity was found to be significantly higher among migrant children. Children and adolescents from the former Yugoslavia and Turkish girls exhibited especially high rates of overweight and obesity. Biosocial and cultural factors are discussed as causes of these observations. (shrink)

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as ‘the obesity epidemic’. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, (...) and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children. (shrink)

The obesity epidemic is not only impairing the health of millions of Americans but also giving rise to billions of added dollars in health care spending. Climbing rates of obesity over the past decades are one of the predominant determinants behind the surging progression of health care expenses in the United States. Moreover, the less fit and less productive U.S. workforce has gradually eroded the nation’s industrial competitiveness. Since the early 1970s, adult obesity rates have doubled and (...) childhood obesity rates have more than tripled, while health expenditures have risen two percentage points faster than the Gross Domestic Product, burgeoning from 8.8 percent in 1980 to a projected 17.9 percent in 2011. Studies analyze that greater than a quarter of America’s health care expenses are attributed to obesity. The stunning growth in obesity has been imputed for 20 to 30 percent of the increase in health care costs since the late 1970s. If the proportion of obese population had stayed unchanged, then health care expenditures in America would be approximately 10 percent less on a per capita average than they are today. (shrink)

This study draws the attention towards the importance of reducing weight discrimination against children for their educational success, as an issue of social justice. We investigate the consequences of early-onset obesity identifying the mediating mechanisms in the relationship between childhood obesity and academic achievement. To do so, we employ the Early Childhood Longitudinal Study-Kindergarten Cohort in the US and apply a parallel process latent growth model with a combination of quasi-experiments and econometrics. The results of this (...) study suggest that teachers may serve as a significant source of weight bias, especially for girls. (shrink)

This article examines how childhood has become a strategy that answers to questions concerning the governability of life. The analysis is organized around the concept of “biosocial power,” which is shown to be a particular zone of intensity within the wider field of biopolitics. To grasp this intensity it is necessary to attend to the place of imagination in staging biosocial strategies, that is the specific ways in which childhood is both an imaginary projection and a technical project, (...) and to this end Agamben’s concept of the “anthropological machine” is used to examine how biosocial power has been assembled and deployed. The paper begins with the question of childhood as it was posed towards the end of the nineteenth century, focusing on how this positioned the figure of the child at the intersection of zoē and bios, animal and human, past and future. It ends with a discussion on how the current global obesity “epidemic” has transformed this one-time vision of mastery into a strategy of survival. (shrink)

In 2010, a South Carolina mother was taken to court when her fourteen‐year‐old son reached 555 pounds. An article on the story reported, “His mother, Jerri Gray, lost custody of her son and is being charged with criminal neglect. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity.” If the caretakers of obese children are negligent, then they are also morally and legally blameworthy. I want to suggest, however, that important (...) ethical differences exist between negligent or abusive caretakers and the caretakers of obese children and that these differences ought to make a moral and legal difference. The distinctions are nuanced, and the ethical pictures in cases of abuse, neglect, and obesity are far from black and white. However, the various types of harm that children face from their caretakers should be placed in neither the same ethical nor the same legal category.When children are beaten or sexually molested, the justification for taking them out of the home is clear: the caretakers are violating the rights of their children. Similarly, with neglect, caretakers are failing to provide their children the necessities to which they are entitled. The central question that I want to address in this article is whether the actions (or inaction) of caretakers that allow a child to become obese are morally or practically analogous to physical abuse or neglect. Ultimately, I will argue that parenting that allows a child to become obese is so morally different from both abuse and neglect that it is best understood as falling outside these categories altogether. This conclusion has important moral, practical, and legal implications. (shrink)

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as ‘the obesity epidemic’. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, (...) and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children. (shrink)

Cardiff Law School, Museum Avenue, Cardiff CF10 3AX, UK. Tel: +44(0)2920875447, Fax: +44(0)2920874097; Email: Holms{at}cardiff.ac.uk ' + u + '@' + d + ' '//--> Abstract The paper presents a brief overview of current knowledge about (i) the link between parental behaviour and lifestyle and childhood obesity, (ii) the many other factors influencing overweight and obesity rates in children and (iii) the effectiveness of interventions in children who are already overweight and obese. On the basis of this, (...) it is analysed to what extent it is meaningful to attribute causal and moral responsibility to parents in theory and in practice. It is argued that although there is a sense in which many parents are causally and morally responsible for the obesity of their children, most parents are not blameworthy and the attribution of parental responsibility in most cases does not justify intervention in the family context by society on behalf of the children. In the analysis of the possible justification of more general interventions, parallels are drawn to the distinction between hard and soft forms of paternalism. Train up a child in the way he should go; and when he is old, he will not depart from it. (Proverbs 22: 6) For I have told him that I will judge his house for ever for the iniquity which he knoweth; because his sons made themselves vile, and he restrained them not. 1. (Samuel 3: 13) CiteULike Connotea Del.icio.us What's this? (shrink)

Science and Community: Ending Obesity Improving Health (S&C) aimed to reduce obesity in Houston by developing community partnerships to identify research priorities and develop a sustainable obesity reduction program. Partnership members were recruited from S&C events and invited to participate in in‐depth interviews to gain insight into obesity prevalence, causes, and solutions. Members (n = 22) completed a 60–90‐min in‐depth interview. The interview guide consisted of 30 questions about pressing health problems in the community, potential solutions (...) to health problems and obesity and how the environment has impacted obesity and health behaviors in the community. Interviewees (n = 12 women and 10 men) were mostly Hispanic/Latino (n = 9) and African American (n = 7). Common problems identified were childhood obesity, balancing a healthy diet and physical inactivity. Interviewees identified obesity as a major problem in their communities and cited access to quality food and physical activity resources as both a problem and a solution. Additional emergent themes focused on solutions, including increasing awareness and education, coordinated efforts among organizations and using an ecologic approach to combat obesity. Community insight gleaned from this study may be used to enhance relevance and sustainability of programs developed to reduce obesity and suggests possible avenues for participatory research and intervention. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Obesity as Disease:Definition by DesperationJeremy ShermakI hated removing my shirt. Each visit to my doctor’s office, following a blood pressure and temperature check, the nurse would instruct me to take off my shirt so the doctor could examine me further. She would then leave the room. I remained perched atop the exam table, now half exposed, and a mirror on the wall would not leave me alone. In (...) the reflection, I saw my oversized breasts and “fat roll” oozing out from my pants, hiding my belt. I tried to straighten my back—breathe in, no wait, breathe out—to resculpt the appearance, but it did nothing. I hated myself. Soon, a gentle knock at the door would interrupt the loathing and I’d shake hands with my doctor.I have been obese for the majority of my life—from childhood until I turned 34, when shortly thereafter, I had gastric bypass surgery. Since that time, I have lost 155 pounds and now write this at a comfortable, healthy 180 pounds. That said, my mind remains “obese”. My thinking remains shrouded deep within the obese personality that I embodied for all of those years. I still automatically walk to the big–and–tall section of clothing stores; I don’t recognize the 34–waist pants when they come [End Page 114] out of the dryer; I’m not used to seeing my ribs; and I’m still terrified of that exam room mirror.Upon hearing the news that the American Medical Association (AMA) now classifies obesity as a disease, my initial reaction was that of relief. My recent success was due in large part to the discovery and treatment of hindering endocrinological issues. My history—like repeatedly slamming head–long into a brick wall—suggests that these medically verified roadblocks have existed for some time. Despite my efforts, I didn’t stand a chance.If anyone were a “poster child” for obesity as a disease, it would be me. The lifelong sparring with my weight had its ups and downs; I worked very hard to maintain or lose weight with mixed results. I lost 85 pounds my freshman year of college by running and fervently watching my portions. I kept that weight off for a good five years before the summer of 2003, when I started gaining weight very quickly. I gained 25 pounds in each month of June and July that year, despite maintaining my usual eating habits and running schedule. I soon lost faith. I felt as though I was up against forces that I could not control and I began to forget about losing weight. I didn’t binge, but I didn’t eat well. By 2008, my weight had reached 375 pounds—an all–time personal high.Following a bad relationship and seeking rejuvenation, I embarked on a diet that summer like I’ve never tried before. I cooked everything naturally—from regular dishes like stuffed peppers all the way to condiments like ketchup. It was a militant effort on my part. I lost 50 pounds that summer and felt that I was well on my way back to the body that once felt so comfortable. It was at that point where I hit a wall. I could not get past 321. I can still see that number staring back at me on the scale. It was frustrating. I felt I had done all I could. That’s when I visited a doctor who ran some tests that revealed problems with my hormones and metabolic systems.As it turned out, I had a tumor on my pituitary gland. This may have been the issue all along. That led to low testosterone, which had a really negative impact on my weight loss efforts. After thorough consideration, I decided to have gastric bypass surgery to “reset” my hormones and get a “boost” in my weight loss efforts. It worked.In my particular circumstance, I could view obesity as a disease because its causes, for the most part, were not a result of conscious lifestyle choices. I had no control over the pituitary tumor. However, I know that I could have done more to limit my... (shrink)

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical (...) condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity. (shrink)

BackgroundChildhood adversity is linked to adverse health in adulthood. One posited mechanistic pathway is through physiological responses to acute stress. Childhood adversity has been previously related to both exaggerated and blunted physiological responses to acute stress, however, less is known about the psychological mechanisms which may contribute to patterns of physiological reactivity linked to childhood adversity.ObjectiveIn the current work, we investigated the role of challenge and threat stress appraisals in explaining relationships between childhood adversity and cortisol reactivity (...) in response to an acute stressor.MethodsUndergraduate students completed an online survey that included general demographic information and the Risky Families Questionnaire 24 h before a scheduled lab visit. In the lab, a research assistant collected a baseline salivary cortisol sample. Following the baseline period, participants were read instructions for the Trier Social Stress Test, a validated psychological lab stressor. Next, they completed a challenge vs. threat task appraisal questionnaire and completed the speech and math portion of the TSST. Twenty minutes following the start of the TSST, a second salivary sample was collected to measure changes in salivary cortisol following the TSST.ResultsLinear regression analyses adjusted for age, sex, childhood socioeconomic status, and baseline cortisol levels, showed childhood adversity associated with changes in cortisol levels [B = –0.29 t = –2.35, p = 0.02, R2=0.07]. Linear regression analyses controlling for age, sex, and childhood SES showed childhood adversity associated with both challenge [B = –0.52 t = –5.04, p < 0.001, R2=0.24] and threat [B = 0.55 t = 5.40, p < 0.001, R2=0.27] appraisals. Significant indirect effects of childhood trauma on cortisol reactivity were observed through challenge appraisals [B = –0.01 ], and threat appraisals [B = –0.01 ].ConclusionChildhood adversity may contribute to blunted cortisol reactivity, a pattern of response which is linked to obesity, addiction, and other behavior-related diseases. Our findings suggest that this relationship is in part a product of stress appraisals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Story:Evolving ObesitiesAnonymous OneI am a 66–year–old Caucasian woman. I have always had, either in perception or fact, a “weight problem.” In my childhood and early teens when my weight was within the normal range, I felt fat and was always trying to lose weight. After gaining weight in college, I had a weight problem in body as well as mind. Weight concerns have consumed much of my (...) energy over the years. I have spent most of my life evolving toward a healthy way to manage my weight.Act 1: Obesity as MetaphorI can’t remember ever not feeling fat. Growing up I felt humiliated and shamed by my body, even though I was not overweight, just bigger than my peers, with a pear shape and heavy legs, thighs, and ankles. In high school my BMI, although not used at the time as a measuring tool, was 22.8. Yet despite these facts, I was made to feel fat.In my family being overweight was tantamount to sin. My father and sister were tall and skinny; my mother was petite and shapely. I took after another genetic code—the dumpy ones with knocked knees—the grotesque branch of the family tree. Hand–me–downs from my sister were supposed to fit me, but we were too different, and the difference was not celebrated.Other things were at play, a perfect storm of conditions that contributed to my feelings of worthlessness. I really shouldn’t have been born. The earth should have opened up and swallowed me. Of course I was not conscious of reasons for these feelings at the time. That awareness came later. But these feelings of loss, grief, terror, and terrible wrongness were the context of my struggles over the years.I developed a pattern of binge eating, which satisfied two contradictory impulses: my need to nurture myself combined with my desire to punish myself. The intensity of a binge–eating episode was also an avenue for rage. I was young so the extra calories didn’t result in weight gain, but the behavior had begun to take root.Stepping on the scale was like the final judgment. The scale did not measure weight; it measured value. I would see the number, as would the person weighing me, and my failure, as a person, would be evident. My secret shame would become public. I would be declared guilty for the worthless grub that was me.Nothing else mattered: that I was an A student; that I was kind and compassionate; that I had friends. These facts had no bearing. All that counted was the number on the scale. That number sent a shudder of condemnation down to my very soul. That number threatened to hurl me into a bottomless abyss from which I could not escape.I avoided being weighed. I was a very obedient youth, with an exaggerated respect for authority drilled into me by my father. The one time I ever cut class was in high school. I skipped health class where I had heard we would be weighed.The situations when I could not avoid being weighed confirmed my worst fears. Before one gym class we were publicly weighed in [End Page 96] assembly–line fashion. As I stepped off the scale my gym teacher yelled out “Diet” for all to hear. Doctors who knew nothing about me, to whom I had been sent for various required physicals, told me to lose weight.In the mysterious and internally logical way that the mind works, my weight became a metaphor for all that was reprehensible in me. With no comprehension of why I was so unhappy, it was easy for me to fixate on my weight. It was too horrible to contemplate that I was the problem. The problem with me was my size, my body.As I look back now, I am angry that because of its shape, this perfectly wonderful body was judged as wrong, and that there was no compassionate voice loud enough to contradict this message. But at the time I felt no anger. To feel anger over being made to feel bad requires self–respect... (shrink)

The relative reinforcing value of food measures how hard someone will work for a high-energy-dense food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED to low-energy-dense food would be greater in (...) children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached for cookies and fruit, the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined, and response rates. Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson’s correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores. Statistical significance was defined as p < 0.05. Children with obesity had a greater cookie Pmax [F = 4.95, p = 0.03], higher RRV cookie [F = 4.28, p = 0.04], and responded at a faster rate for cookies [F = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ ; and RRV cookie was positively associated with BMIZ for older children and boys, but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood. (shrink)